Characterization of Functional, Radiologic and Lung Function Recovery Post-Treatment of Hot Tub Lung. A Case Report and Review of the Literature

Abstract

Hot tub lung is described as an acute pulmonary illness that is characterized by fever, dyspnea and interstitial nodular infiltrates. Although not entirely clear, the etiology may be a hypersensitivity pneumonitis, an infection secondary to Mycobacterium avium intracellulare (MAC), or possibly both. Herein we describe the most well-characterized physiologic, radiographic, and functional recovery from hot tub lung reported in the literature to date. Pulmonary function testing and CT scans of the chest were obtained after each therapeutic intervention, and the patient had the most dramatic improvement with simply avoiding the hot tub. Prednisone therapy offered minimal further improvement while anti-MAC therapy provided no further improvement. These results are suggestive of a hypersensitivity pneumonitis rather than an infectious etiology.

Pulmonary Disease Caused by Non-Tuberculous Mycobacteria

“…There is a continuing debate on optimal management of these patients [71]. The fact that a high rate of patients have been reported to be cured by avoidance of the antigen and/or corticosteroid therapy without antimycobacterial therapy suggests that hot tub lung is more likely a form of hypersensitivity pneumonitis than an infectious disease [72,73,74]. …”

Hypersensitivity Pneumonitis-like Granulomatous Lung Disease with Nontuberculous Mycobacteria from Exposure to Hot Water Aerosols

“…This search strategy yielded a total of 263 citations of published articles, including several duplicates. We reviewed the abstracts of resulting citations, and selected citations were retrieved for full review (Aksamit 2003; Cappelluti et al 2003; Embil et al 1997; Grimes et al 2001; Hanak et al 2006; Kahana et al 1997; Khoor et al 2001; Lumb et al 2004; Mangione et al 2001; Marchetti et al 2004; Marras et al 2005; Mery and Horan 2002; O’Neil et al 2006; Pham et al 2003; Rickman et al 2002; Scully et al 1997; Systrom and Wittram 2005; Travaline and Kelsen 2003). Cases published more than once were treated together (Aksamit 2003; Hanak et al 2006; Rickman et al 2002).…”

“…Pulmonary disease due to NTM may take on a variety of clinicopathologic presentations, including cavitary disease, diffuse nodular disease, and interstitial disease. Recently, hypersensitivity pneumonitis (HP)-like granulomatous lung disease with NTM from exposure to hot water aerosols from hot tubs/spa pools, showers, and swimming pools has been described in immunocompetent individuals (also called “hot tub lung,” because the greatest number of cases are associated with hot tubs) (Aksamit 2003; Cappelluti et al 2003; Embil et al 1997; Grimes et al 2001; Hanak et al 2006; Kahana et al 1997; Khoor et al 2001; Koschel et al 2006; Lumb et al 2004; Mangione et al 2001; Marchetti et al 2004; Marras et al 2005; Mery and Horan 2002; O’Neil et al 2006; Pham et al 2003; Rickman et al 2002; Rose et al 2000; Scully et al 1997; Systrom and Wittram 2005; Travaline and Kelsen 2003). Given the increasing popularity of hot tubs in the United States (with > 400,000 hot tubs estimated to have been sold in the year 2000), increased physician and consumer awareness of this disease is warranted.…”

Understanding the importance of biofilm growth in hot tubs

“…Although there is some debate whether to classify hot tub lung as an infection or hypersensitivity pneumonitis (Agarwal and Nath, 2006;Embil et al, 1997;Hanak, et al, 2005;Marchetti et al, 2004;Rickman et al, 2002), regardless, it is a serious illness that requires medical attention. For any respiratory illness associated with aerosolized bacteria, locating the hot tub indoors exasperates the problem (Schafer et al, 2003;Hanak et al, 2005).…”